Gastonia Housing Authority Application For Housing Assistance

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Gastonia Housing Authority
Application for Housing Assistance
Program you are applying for:
_____ Public Housing
_____ Public Housing-Linwood Terrace (must be age 62 or older)
_____ Section 8 Housing Choice voucher program
_____ Section 8 Non-elderly, disabled voucher program (must be below age 62 AND disabled to qualify)
_____ Gateway Village Senior Apartments (must be age 62 or older OR age 55 or older AND in need of supportive services)
_____ Dallas High School Senior Apartments (must be age 62 or older OR age 55 or older AND in need of supportive services)
Name of Head of Household ________________________________________________________________________
Last
First
M
Current Address________________________________________ City, State, Zip Code_________________________
Mailing Address________________________________________ City, State, Zip Code_________________________
Phone number where you can be reached_____________________________________________________________
(Demographic Information for Statistical Purposes Only)
1. Race of Head: □ Caucasian/White □ African American/Black □Asian/Pacific Islander
□ Native American/Alaskan Native □ Mixed race
2. Ethnicity of Head: □ Hispanic/Latino □ Non-Hispanic/Non-Latino
3.
Gender: □ Male □ Female
4. Marital Status : □ Single □ Married □ Separated □ Divorced □ Widowed
Beginning with yourself, list all persons who will live in the unit, including foster children, live-in aides (if
necessary for the care of a family member). Each box must be completed for each family member. No one
except those listed on this form may live in the unit without prior written approval of the housing authority.
First & Last Name
Date of
Sex
Social Security
Relationship
Disabled
Full-time
Birth
Number
to Head of
Person?
Student?
Household
Yes or
Yes or No
No
H
SELF
2
3
4
5
6
7
8
1. Have you or anyone who will live in the assisted household ever been arrested, charged or convicted of a
crime other than a traffic violation?
□ YES
□ NO
If yes, please explain the nature of the offense including
the county and state, the date of the charge and the name of the family member who was involved:
_________________________________________________________________________________________________
_ _______________________________________________________________________________________________
2. Have you ever received housing assistance through Public Housing or through the Section 8 Housing Choice
Voucher Program before? □ YES
□ NO
C:\Users\Caylyn\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\129M47J2\Pre-application open WL.doc

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